Provider Demographics
NPI:1144065087
Name:LUNDY, CHEYENNE M
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:M
Last Name:LUNDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:859 SCOTCH HALL WAY APT 101
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5186
Mailing Address - Country:US
Mailing Address - Phone:910-644-6796
Mailing Address - Fax:
Practice Address - Street 1:5431 TRADE ST
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-1939
Practice Address - Country:US
Practice Address - Phone:912-445-2098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBACB1143594106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician